The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (1), Page 3749-3752 3749 Received:6 / 4 /2018 DOI: 10.12816/0047740 Accepted:15 / 4 /2018 Efficacy and Safety of Colistin for Treatment of Multidrug-Resistant Acinetobacter Baumannii Alharthi Khuwilid R 1 , Alasiri Abdullah K 2* , Alshehri Ibrahim M 3 , Almutairi Masaad A 4 Departments of Clinical Pharmacy 1- King Abdullah Hospital, Bishah, 2- Medina General Hospital, Medina,3- Rabigh General Hospital, Jeddah, 4- Almahd General Hospital, Medina *Corresponding author: Alasiri Abdullah K, Mobile No.+966560050083, E-Mail: [email protected] ABSTRACT Background: Antibiotic resistance of Acinetobacter baumannii causes various communicable diseases and increases the risks of admission to intensive care units (ICUs) with high morbidity and mortality rates. Objectives: Evaluating the efficacy of colistin usage guidelines and recommendations among critically ill patient infected by a multidrug-resistant Acinetobacter baumannii. Methods: An observational cross sectional study that was performed during the period from June to August 2017 among 127 critically ill patients who were treated with colistin for multidrug-resistant Acinetobacter baumannii using bacterial culture and proper identification methods. Evaluations of CRP, bacterial culture, BUN and serum creatinine level were routinely done pre- and post-treatment. Results: The method of administrating colistin was through intravenous infusion among all the patients and the most common indication of colistin usage were pneumonia followed by UTI. All the patients were susceptible to colistin and shown a negative bacterial cultures among most of the patients. The creatinine level was elevated (>2 mg/dL) showing nephrotoxicity among 11% of the patient. No allergic, neurological effects or mortality rates were observed in the study. Conclusion: The findings of the recent study revealed that colistin is the best therapeutic treatment for A. baumannii in KSA hospitals due to their broad-spectrum activity that may make them the most important choice for serious communicable and hospital acquired infections. Proper monitoring of the side-effects of colistin especially nephrotoxic effects through routine evaluation of creatinine level to detect the renal injury and adjusting the doses or combination of colistin low dose with other antibiotics. Keywords: Colistin, Acinetobacter baumannii (A. baumannii), resistance, monitoring, critically Ill, KSA. INTRODUCTION Bacterial resistance against antibiotics is a major health problem around the world that impacts the urgent need for development of new medications that may not be available and cost time and money (1, 2) . The resistance of gram negative bacteria outbreaks including Pseudomonas species and Acinetobacter species could result in vast worldwide health implications and increase morbidity and mortality rate (3) . Acinetobacter baumannii, (A. baumannii is a gram positive opportunistic pathogen that causes various communicable diseases and increases the risks of admission to intensive care units (ICUs) with high morbidity and mortality rates (4-6) . The treatment of choice for Acinetobacter species is carbapenems medication but due to the overuse of these medications has resulted in development of Metallo beta lactamase (MBL) producing bacteria (7) . Although, some antibiotics still active against this type of bacteria (5, 8) . The Polymyxins are being used for many years for treatment of Metallo beta lactamase (MBL) producing bacteria as they consisted of 5 different compounds with polypeptide less toxic antibiotics that chiefly works on the bacterial cytoplasmic membrane of bacterial cell (4, 9) . Colistin is a polymyxin E that is clinically used for Acinetobacter (A.) baumannii (10, 11) . However, some adverse effects of colistin including renal, pulmonary and neurological toxicities after intravenous injection (12) . Furthermore, some patients may suffer from gastrointestinal events, allergic reactions and pulmonary toxicities (13) . AIM OF STUDY The present study aimed to evaluate the efficacy of colistin usage guidelines and recommendations among critically ill patients infected by a multidrug-resistant Acinetobacter baumannii. METHODS Study design: An observational cross sectional study that was conducted at King Abdullah Hospital (KAH) - bishah, Kingdom of Saudi Arabia (KSA), from June to August 2017. Study population: All the patients who were treated with colistin for multidrug-resistant Acinetobacter baumannii using
Efficacy and Safety of Colistin for Treatment of Multidrug-Resistant Acinetobacter Baumannii
Jun 02, 2022
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The Egyptian Journal of Hospital Medicine (July 2018) Vol. 72 (1), Page 3749-3752
3749
Accepted:15 / 4 /2018
Acinetobacter Baumannii Alharthi Khuwilid R
1 , Alasiri Abdullah K
2* , Alshehri Ibrahim M
3 , Almutairi Masaad A
Departments of Clinical Pharmacy
1- King Abdullah Hospital, Bishah, 2- Medina General Hospital, Medina,3- Rabigh General Hospital, Jeddah,
4- Almahd General Hospital, Medina *Corresponding author: Alasiri Abdullah K, Mobile No.+966560050083, E-Mail: [email protected]
ABSTRACT
Background: Antibiotic resistance of Acinetobacter baumannii causes various communicable diseases and
increases the risks of admission to intensive care units (ICUs) with high morbidity and mortality rates.
Objectives: Evaluating the efficacy of colistin usage guidelines and recommendations among critically ill patient
infected by a multidrug-resistant Acinetobacter baumannii.
Methods: An observational cross sectional study that was performed during the period from June to August
2017 among 127 critically ill patients who were treated with colistin for multidrug-resistant Acinetobacter
baumannii using bacterial culture and proper identification methods. Evaluations of CRP, bacterial culture, BUN
and serum creatinine level were routinely done pre- and post-treatment.
Results: The method of administrating colistin was through intravenous infusion among all the patients and the
most common indication of colistin usage were pneumonia followed by UTI. All the patients were susceptible to
colistin and shown a negative bacterial cultures among most of the patients. The creatinine level was elevated
(>2 mg/dL) showing nephrotoxicity among 11% of the patient. No allergic, neurological effects or mortality
rates were observed in the study.
Conclusion: The findings of the recent study revealed that colistin is the best therapeutic treatment for A.
baumannii in KSA hospitals due to their broad-spectrum activity that may make them the most important choice
for serious communicable and hospital acquired infections. Proper monitoring of the side-effects of colistin
especially nephrotoxic effects through routine evaluation of creatinine level to detect the renal injury and
adjusting the doses or combination of colistin low dose with other antibiotics.
Keywords: Colistin, Acinetobacter baumannii (A. baumannii), resistance, monitoring, critically Ill, KSA.
INTRODUCTION Bacterial resistance against antibiotics is a major
health problem around the world that impacts the
urgent need for development of new medications
that may not be available and cost time and money (1, 2)
. The resistance of gram negative bacteria
outbreaks including Pseudomonas species and
Acinetobacter species could result in vast
worldwide health implications and increase
morbidity and mortality rate (3)
. Acinetobacter
opportunistic pathogen that causes various
communicable diseases and increases the risks of
admission to intensive care units (ICUs) with high
morbidity and mortality rates (4-6)
.
these medications has resulted in development of
Metallo beta lactamase (MBL) producing bacteria (7)
. Although, some antibiotics still active against
this type of bacteria (5, 8)
.
treatment of Metallo beta lactamase (MBL)
producing bacteria as they consisted of 5 different
compounds with polypeptide less toxic antibiotics
that chiefly works on the bacterial cytoplasmic
membrane of bacterial cell (4, 9)
.
Colistin is a polymyxin E that is clinically used for
Acinetobacter (A.) baumannii (10, 11)
. However,
pulmonary and neurological toxicities after
intravenous injection (12)
.
colistin usage guidelines and recommendations
among critically ill patients infected by a
multidrug-resistant Acinetobacter baumannii.
conducted at King Abdullah Hospital (KAH) -
bishah, Kingdom of Saudi Arabia (KSA), from
June to August 2017.
multidrug-resistant Acinetobacter baumannii using
3750
were enrolled in the present study. The study
included 127 patients during the study period.
Data collection:
comprised of demographic variables as age and sex.
The history of medications, diagnosis and types of
infections were recorded. Also, laboratory
investigation as microbiological culture, serum
creatinine, blood urea nitrogen (BUN) and C-
reactive protein [CRP] were analyzed before and
during initiation of treatment.
Hospital and the policy of hospital was respected.
RESULTS
A total of eligible127 patients were included in the
study, the mean age of patients ranged from 44-67
years old with a mean of 53.2 years old. Most of the
patients (61.4%) were males while 38.6% were
females. The method of administrating colistin was
through intravenous infusion among all the patients.
Also, the indications of colistin usage were
pneumonia among most of the participants
followed by UTI then sepsis and wound infection.
Table 1: Socio-Demographic Characteristics of Included Participants
Age (Year)
Mean±SD
Sepsis 15 11.8%
vancomycin. Bacterial cultures were assessed pre-
and post-treatment where most of the patients (122
patients, 96.1%) had negative microbiological
cultures and eradication of pathogens after 5-8 days
of treatments also after 3 days of treatment, 96
patients (75.6%) had negative. While 3.9% still had
positive bacterial cultures after 8 days of treatments.
The CRP level was an indicator for colistin
effectiveness where most of the patients showed
reduced levels of CRP after treatment which
decreased more with time. The serum BUN level
showed no change either pre- or post-treatment while
the creatinine level was elevated (>2 mg/dL) showing
nephrotoxicity among 14 (11%) patients where the
dose was adjusted among most of them.
- Other side effects:
neurological were not observed among all the
included patients including paresthesia, vertigo,
apnea and muscle weakness.
nephrotoxicity.
DISCUSSION
decades due to low awareness and practice pattern of
appropriate and correct or excessive usage of
antibiotics (14,15)
of using colistin were pneumonia in most of the cases
followed by urinary tract infections, sepsis and the
least was wound infection. In the same respect, using
colistin for treatment of hospital acquired infections
especially pneumonia and UTI (10,16, 17)
.
patients (122 patients, 96.1%) had negative
microbiological cultures and eradication of pathogens
after 5-8 days of treatments also after 3 days of
treatment, 96 patients (75.6%) had negative. While
3.9% still had positive bacterial cultures after 8 days
of treatments. Consistent studies showed that most of
isolated A. baumannii were susceptible to colistin (18,
19) . Also, lower rates resistance were found toward
colistin among patients with??? at Shiraz hospital (14)
.
of the patients who were susceptible to colistin
treatment either alone or with other antibiotics (20-22)
.
who had higher levels of creatinine thus the doses of
colistin were adjusted till the values returned to
normal which showed proper monitoring of the side
effects of colistin among the patients (23, 24)
. On the
shown among the patients and this could be attributed
to that most of the patients administrated sedatives
and analgesics.
injury was found to be the most common adverse
effect of colistin treatment and this could be
attributed to improper patients monitoring during the
treatment period (16, 25)
colistin is the best therapeutic treatments for
A.baumannii in KSA hospitals due to their broad-
spectrum activity that may make them the most
important choice for serious communicable and
hospital acquired infections. Proper monitoring of the
side-effects of colistin especially nephrotoxic effects
through routine evaluation of creatinine level to
detect the renal injury and adjusting the doses or
combination of colistin with other antibiotics.
REFERENCES 1.McArthur AG, Waglechner N, Nizam F, Yan A, Azad
MA, Baylay AJ et al. (2013): The Comprehensive
Antibiotic Resistance Database. Antimicrobial agents and
chemotherapy, 57: 3348-3357.
resistance surveillance in the genomic age. Annals of the
New York Academy of Sciences, 1388: 78-91.
3.Lim TP, Tan TY, Lee W, Sasikala S, Tan TT, Hsu LY
et al. (2009): In vitro activity of various combinations of
antimicrobials against carbapenem-resistant Acinetobacter
679.
HS (2006): Dissemination of IMP-1 metallo- beta -
lactamase-producing Acinetobacter species in a Brazilian
teaching hospital. Infection control and hospital
epidemiology, 27: 742-747.
Mirsalehian A, Sohrabi N et al. (2011): High prevalence
of metallo-beta-lactamase-producing acinetobacter
journal of infectious diseases, 64: 69-71.
6.Hong DJ, Bae IK, Jang IH, Jeong SH, Kang HK, Lee
K (2015): Epidemiology and Characteristics of Metallo-
beta-Lactamase-Producing Pseudomonas aeruginosa.
3752
lactamases and their genetic association with class 1
integrons and ISCR elements in Gram-negative bacteria.
Future Microbiol., 10: 873-887.
of polymyxins for the management of multidrug-resistant
gram-negative bacterial infections. Clinical infectious
diseases : an official publication of the Infectious Diseases
Society of America, 40: 1333-1341.
9.Somily AM, Absar MM, Arshad MZ, Al Aska AI,
Shakoor ZA, Fatani AJ et al. (2012): Antimicrobial
susceptibility patterns of multidrug-resistant Pseudomonas
aeruginosa and Acinetobacter baumannii against
carbapenems, colistin, and tigecycline. Saudi medical
journal, 33: 750-755.
efficacy and safety in different populations. Expert review
of clinical pharmacology, 8: 423-448.
11.Luque S, Grau S, Valle M, Sorli L, Horcajada JP,
Segura C et al. (2013): Differences in pharmacokinetics
and pharmacodynamics of colistimethate sodium (CMS)
and colistin between three different CMS dosage regimens
in a critically ill patient infected by a multidrug-resistant
Acinetobacter baumannii. International journal of
antimicrobial agents, 42: 178-181.
Mazuan WM, Ling SM, Mahmud A, Amin Nordin S
(2017): Colistin-associated nephrotoxicity among patients
in intensive care units (ICU) of hospitals in Selangor. The
Medical journal of Malaysia, 72: 100-105.
13.Benattar YD, Omar M, Zusman O, Yahav D, Zak-
Doron Y, Altunin S et al. (2016): The Effectiveness and
Safety of High-Dose Colistin: Prospective Cohort Study.
Clinical infectious diseases : an official publication of the
Infectious Diseases Society of America, 63: 1605-1612.
14.Vazin A, Karimzadeh I, Zand A, Hatami-Mazinani
N, Firouzabadi D (2017): Evaluating Adherence of
Health-Care Team to Standard Guideline of Colistin Use at
Intensive Care Units of a Referral Hospital in Shiraz,
Southwest of Iran. Advanced Pharmaceutical Bulletin, 7:
391-397.
resistant Acinetobacter in neonates. Annals of clinical
microbiology and antimicrobials, 15: 8.
16.Michalopoulos AS, Tsiodras S, Rellos K,
Mentzelopoulos S, Falagas ME (2005): Colistin
treatment in patients with ICU-acquired infections caused
by multiresistant Gram-negative bacteria: the renaissance
of an old antibiotic. Clinical Microbiology and Infection,
11: 115-121.
17.Doron S, Davidson LE (2011): Antimicrobial
stewardship. Mayo Clinic proceedings, 86: 1113-1123.
18.Zavascki AP, Goldani LZ, Li J, Nation RL (2007): Polymyxin B for the treatment of multidrug-resistant
pathogens: a critical review. The Journal of antimicrobial
chemotherapy, 60: 1206-1215.
tigecycline suspectibility to metallo betalactamase
producing Acinetobacter baumannii isolated from tertiary
health care hospital. American Journal of Microbiological
Research, 2: 60-62.
Alikhani MY (2013): High prevalence of multidrug
resistance and metallo-beta-lactamase (MbetaL) producing
Acinetobacter baumannii isolated from patients in ICU
wards, Hamadan, Iran. Journal of research in health
sciences, 13: 162-167.
MA, Rostami S, Ebrahimi N (2013): Genotyping of
carbapenem resistant Acinetobacter baumannii isolated
from tracheal tube discharge of hospitalized patients in
intensive care units, Ahvaz, Iran. Iranian journal of
microbiology, 5: 315-322.
Abiri R, Najafi F (2013): Antimicrobial susceptibility
profiling and genomic diversity of Acinetobacter
baumannii isolates: A study in western Iran. Iranian journal
of microbiology, 5: 195-202.
ML, Coppolecchia S et al. (2012): High-dose, extended-
interval colistin administration in critically ill patients: is
this the right dosing strategy? A preliminary study. Clinical
infectious diseases : an official publication of the
Infectious Diseases Society of America, 54: 1720-1726.
24.Ordooei Javan A, Shokouhi S, Sahraei Z (2015): A
review on colistin nephrotoxicity. European journal of
clinical pharmacology, 71: 801-810.
Garmendia JL, Bernabeu-Wittel IM et al. (2003): Treatment of multidrug-resistant Acinetobacter baumannii
ventilator-associated pneumonia (VAP) with intravenous
colistin: a comparison with imipenem-susceptible VAP.
Clinical infectious diseases : an official publication of the
Infectious Diseases Society of America, 36: 1111-1118.
3749
Accepted:15 / 4 /2018
Acinetobacter Baumannii Alharthi Khuwilid R
1 , Alasiri Abdullah K
2* , Alshehri Ibrahim M
3 , Almutairi Masaad A
Departments of Clinical Pharmacy
1- King Abdullah Hospital, Bishah, 2- Medina General Hospital, Medina,3- Rabigh General Hospital, Jeddah,
4- Almahd General Hospital, Medina *Corresponding author: Alasiri Abdullah K, Mobile No.+966560050083, E-Mail: [email protected]
ABSTRACT
Background: Antibiotic resistance of Acinetobacter baumannii causes various communicable diseases and
increases the risks of admission to intensive care units (ICUs) with high morbidity and mortality rates.
Objectives: Evaluating the efficacy of colistin usage guidelines and recommendations among critically ill patient
infected by a multidrug-resistant Acinetobacter baumannii.
Methods: An observational cross sectional study that was performed during the period from June to August
2017 among 127 critically ill patients who were treated with colistin for multidrug-resistant Acinetobacter
baumannii using bacterial culture and proper identification methods. Evaluations of CRP, bacterial culture, BUN
and serum creatinine level were routinely done pre- and post-treatment.
Results: The method of administrating colistin was through intravenous infusion among all the patients and the
most common indication of colistin usage were pneumonia followed by UTI. All the patients were susceptible to
colistin and shown a negative bacterial cultures among most of the patients. The creatinine level was elevated
(>2 mg/dL) showing nephrotoxicity among 11% of the patient. No allergic, neurological effects or mortality
rates were observed in the study.
Conclusion: The findings of the recent study revealed that colistin is the best therapeutic treatment for A.
baumannii in KSA hospitals due to their broad-spectrum activity that may make them the most important choice
for serious communicable and hospital acquired infections. Proper monitoring of the side-effects of colistin
especially nephrotoxic effects through routine evaluation of creatinine level to detect the renal injury and
adjusting the doses or combination of colistin low dose with other antibiotics.
Keywords: Colistin, Acinetobacter baumannii (A. baumannii), resistance, monitoring, critically Ill, KSA.
INTRODUCTION Bacterial resistance against antibiotics is a major
health problem around the world that impacts the
urgent need for development of new medications
that may not be available and cost time and money (1, 2)
. The resistance of gram negative bacteria
outbreaks including Pseudomonas species and
Acinetobacter species could result in vast
worldwide health implications and increase
morbidity and mortality rate (3)
. Acinetobacter
opportunistic pathogen that causes various
communicable diseases and increases the risks of
admission to intensive care units (ICUs) with high
morbidity and mortality rates (4-6)
.
these medications has resulted in development of
Metallo beta lactamase (MBL) producing bacteria (7)
. Although, some antibiotics still active against
this type of bacteria (5, 8)
.
treatment of Metallo beta lactamase (MBL)
producing bacteria as they consisted of 5 different
compounds with polypeptide less toxic antibiotics
that chiefly works on the bacterial cytoplasmic
membrane of bacterial cell (4, 9)
.
Colistin is a polymyxin E that is clinically used for
Acinetobacter (A.) baumannii (10, 11)
. However,
pulmonary and neurological toxicities after
intravenous injection (12)
.
colistin usage guidelines and recommendations
among critically ill patients infected by a
multidrug-resistant Acinetobacter baumannii.
conducted at King Abdullah Hospital (KAH) -
bishah, Kingdom of Saudi Arabia (KSA), from
June to August 2017.
multidrug-resistant Acinetobacter baumannii using
3750
were enrolled in the present study. The study
included 127 patients during the study period.
Data collection:
comprised of demographic variables as age and sex.
The history of medications, diagnosis and types of
infections were recorded. Also, laboratory
investigation as microbiological culture, serum
creatinine, blood urea nitrogen (BUN) and C-
reactive protein [CRP] were analyzed before and
during initiation of treatment.
Hospital and the policy of hospital was respected.
RESULTS
A total of eligible127 patients were included in the
study, the mean age of patients ranged from 44-67
years old with a mean of 53.2 years old. Most of the
patients (61.4%) were males while 38.6% were
females. The method of administrating colistin was
through intravenous infusion among all the patients.
Also, the indications of colistin usage were
pneumonia among most of the participants
followed by UTI then sepsis and wound infection.
Table 1: Socio-Demographic Characteristics of Included Participants
Age (Year)
Mean±SD
Sepsis 15 11.8%
vancomycin. Bacterial cultures were assessed pre-
and post-treatment where most of the patients (122
patients, 96.1%) had negative microbiological
cultures and eradication of pathogens after 5-8 days
of treatments also after 3 days of treatment, 96
patients (75.6%) had negative. While 3.9% still had
positive bacterial cultures after 8 days of treatments.
The CRP level was an indicator for colistin
effectiveness where most of the patients showed
reduced levels of CRP after treatment which
decreased more with time. The serum BUN level
showed no change either pre- or post-treatment while
the creatinine level was elevated (>2 mg/dL) showing
nephrotoxicity among 14 (11%) patients where the
dose was adjusted among most of them.
- Other side effects:
neurological were not observed among all the
included patients including paresthesia, vertigo,
apnea and muscle weakness.
nephrotoxicity.
DISCUSSION
decades due to low awareness and practice pattern of
appropriate and correct or excessive usage of
antibiotics (14,15)
of using colistin were pneumonia in most of the cases
followed by urinary tract infections, sepsis and the
least was wound infection. In the same respect, using
colistin for treatment of hospital acquired infections
especially pneumonia and UTI (10,16, 17)
.
patients (122 patients, 96.1%) had negative
microbiological cultures and eradication of pathogens
after 5-8 days of treatments also after 3 days of
treatment, 96 patients (75.6%) had negative. While
3.9% still had positive bacterial cultures after 8 days
of treatments. Consistent studies showed that most of
isolated A. baumannii were susceptible to colistin (18,
19) . Also, lower rates resistance were found toward
colistin among patients with??? at Shiraz hospital (14)
.
of the patients who were susceptible to colistin
treatment either alone or with other antibiotics (20-22)
.
who had higher levels of creatinine thus the doses of
colistin were adjusted till the values returned to
normal which showed proper monitoring of the side
effects of colistin among the patients (23, 24)
. On the
shown among the patients and this could be attributed
to that most of the patients administrated sedatives
and analgesics.
injury was found to be the most common adverse
effect of colistin treatment and this could be
attributed to improper patients monitoring during the
treatment period (16, 25)
colistin is the best therapeutic treatments for
A.baumannii in KSA hospitals due to their broad-
spectrum activity that may make them the most
important choice for serious communicable and
hospital acquired infections. Proper monitoring of the
side-effects of colistin especially nephrotoxic effects
through routine evaluation of creatinine level to
detect the renal injury and adjusting the doses or
combination of colistin with other antibiotics.
REFERENCES 1.McArthur AG, Waglechner N, Nizam F, Yan A, Azad
MA, Baylay AJ et al. (2013): The Comprehensive
Antibiotic Resistance Database. Antimicrobial agents and
chemotherapy, 57: 3348-3357.
resistance surveillance in the genomic age. Annals of the
New York Academy of Sciences, 1388: 78-91.
3.Lim TP, Tan TY, Lee W, Sasikala S, Tan TT, Hsu LY
et al. (2009): In vitro activity of various combinations of
antimicrobials against carbapenem-resistant Acinetobacter
679.
HS (2006): Dissemination of IMP-1 metallo- beta -
lactamase-producing Acinetobacter species in a Brazilian
teaching hospital. Infection control and hospital
epidemiology, 27: 742-747.
Mirsalehian A, Sohrabi N et al. (2011): High prevalence
of metallo-beta-lactamase-producing acinetobacter
journal of infectious diseases, 64: 69-71.
6.Hong DJ, Bae IK, Jang IH, Jeong SH, Kang HK, Lee
K (2015): Epidemiology and Characteristics of Metallo-
beta-Lactamase-Producing Pseudomonas aeruginosa.
3752
lactamases and their genetic association with class 1
integrons and ISCR elements in Gram-negative bacteria.
Future Microbiol., 10: 873-887.
of polymyxins for the management of multidrug-resistant
gram-negative bacterial infections. Clinical infectious
diseases : an official publication of the Infectious Diseases
Society of America, 40: 1333-1341.
9.Somily AM, Absar MM, Arshad MZ, Al Aska AI,
Shakoor ZA, Fatani AJ et al. (2012): Antimicrobial
susceptibility patterns of multidrug-resistant Pseudomonas
aeruginosa and Acinetobacter baumannii against
carbapenems, colistin, and tigecycline. Saudi medical
journal, 33: 750-755.
efficacy and safety in different populations. Expert review
of clinical pharmacology, 8: 423-448.
11.Luque S, Grau S, Valle M, Sorli L, Horcajada JP,
Segura C et al. (2013): Differences in pharmacokinetics
and pharmacodynamics of colistimethate sodium (CMS)
and colistin between three different CMS dosage regimens
in a critically ill patient infected by a multidrug-resistant
Acinetobacter baumannii. International journal of
antimicrobial agents, 42: 178-181.
Mazuan WM, Ling SM, Mahmud A, Amin Nordin S
(2017): Colistin-associated nephrotoxicity among patients
in intensive care units (ICU) of hospitals in Selangor. The
Medical journal of Malaysia, 72: 100-105.
13.Benattar YD, Omar M, Zusman O, Yahav D, Zak-
Doron Y, Altunin S et al. (2016): The Effectiveness and
Safety of High-Dose Colistin: Prospective Cohort Study.
Clinical infectious diseases : an official publication of the
Infectious Diseases Society of America, 63: 1605-1612.
14.Vazin A, Karimzadeh I, Zand A, Hatami-Mazinani
N, Firouzabadi D (2017): Evaluating Adherence of
Health-Care Team to Standard Guideline of Colistin Use at
Intensive Care Units of a Referral Hospital in Shiraz,
Southwest of Iran. Advanced Pharmaceutical Bulletin, 7:
391-397.
resistant Acinetobacter in neonates. Annals of clinical
microbiology and antimicrobials, 15: 8.
16.Michalopoulos AS, Tsiodras S, Rellos K,
Mentzelopoulos S, Falagas ME (2005): Colistin
treatment in patients with ICU-acquired infections caused
by multiresistant Gram-negative bacteria: the renaissance
of an old antibiotic. Clinical Microbiology and Infection,
11: 115-121.
17.Doron S, Davidson LE (2011): Antimicrobial
stewardship. Mayo Clinic proceedings, 86: 1113-1123.
18.Zavascki AP, Goldani LZ, Li J, Nation RL (2007): Polymyxin B for the treatment of multidrug-resistant
pathogens: a critical review. The Journal of antimicrobial
chemotherapy, 60: 1206-1215.
tigecycline suspectibility to metallo betalactamase
producing Acinetobacter baumannii isolated from tertiary
health care hospital. American Journal of Microbiological
Research, 2: 60-62.
Alikhani MY (2013): High prevalence of multidrug
resistance and metallo-beta-lactamase (MbetaL) producing
Acinetobacter baumannii isolated from patients in ICU
wards, Hamadan, Iran. Journal of research in health
sciences, 13: 162-167.
MA, Rostami S, Ebrahimi N (2013): Genotyping of
carbapenem resistant Acinetobacter baumannii isolated
from tracheal tube discharge of hospitalized patients in
intensive care units, Ahvaz, Iran. Iranian journal of
microbiology, 5: 315-322.
Abiri R, Najafi F (2013): Antimicrobial susceptibility
profiling and genomic diversity of Acinetobacter
baumannii isolates: A study in western Iran. Iranian journal
of microbiology, 5: 195-202.
ML, Coppolecchia S et al. (2012): High-dose, extended-
interval colistin administration in critically ill patients: is
this the right dosing strategy? A preliminary study. Clinical
infectious diseases : an official publication of the
Infectious Diseases Society of America, 54: 1720-1726.
24.Ordooei Javan A, Shokouhi S, Sahraei Z (2015): A
review on colistin nephrotoxicity. European journal of
clinical pharmacology, 71: 801-810.
Garmendia JL, Bernabeu-Wittel IM et al. (2003): Treatment of multidrug-resistant Acinetobacter baumannii
ventilator-associated pneumonia (VAP) with intravenous
colistin: a comparison with imipenem-susceptible VAP.
Clinical infectious diseases : an official publication of the
Infectious Diseases Society of America, 36: 1111-1118.
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